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e�a-�aaoozo U� City of.Zephy�hiUs Fir:e� FaX-eta-�ao-oozi <br /> I� �j?%�d'GGjC Permit Application <br /> )ate Received � � �� a.s� /S /l Phone Contact for Pertnit � � ��� J.� /, <br /> 's;ar�•.s.� . - - -ar -- -- -_°'�" ��..-ss�-�.,��+��° ��,�°'-..�.,___...-.4s.s.��;....�:..�,.,.-_. —�_ <br /> )wner's Name L: �� %/�/� �� Owners Phone Number g/ ��� .-/ 3� I <br /> )wner's Address T, O• O'\ /�cJ / / �� 3 3 67 <br /> ee Simpie Titleholder Name Titieholder Phone Number �� � <br /> ee Simple l'itleholder Address <br /> � "'":.�s.s�.�`:��'�� _ �� �w�_�.r �� - �*T'etiri:.�" ��� ' <br /> ob Address ��/ � C.- J � � �� Lot � �1 <br /> ;ub Division �3 /T � /�� � � � Parcel # <br /> � <br /> � Bio-Hazarti Waste Storage - ANNUAL a Fumigation Tent <br /> a Comm Exhaust Kitchen Hood/Duct a Hazardous Material (fier II or RQ Facility) ANNUAL <br /> � Controlled 8um � Hood Installation <br /> � Emergency Generator < 30 kw a LP/Natural Gas-InstallaUon _ <br /> � Emergency Generator > 30 kw � LP/Natural Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL � Places of Assembly-ANNUAL <br /> �y emi �n er <br /> Sprinkler � O ❑ ❑ a RecreaGonal Bum �� <br /> Fire Atarm � ❑ � � � � Sparlclers � <br /> Hood Cleaning � ❑ O �� a 5prinkler System Instailatio s`�� � <br /> .��v <br /> Hood Suppression ❑ ❑ ❑ � � Standpipes (Sprinkter Sys) c / <br /> � Fire Alartn Installation � 7orch Roofing(Tar Kettle <br /> � Fire Pumps a �Naste Tire Storage ANNUAL <br /> � Fire Wo�lcs <br /> a Fiammable Appiication- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other <br /> �ontractor Company � <br /> 5ignature �L� Registered �( / N Fee Current Y/ N <br /> Address License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> PLUMBER Company <br /> Signature Registered Y/ N , Fee Current _Y / N <br /> Address License # <br /> MECHANICAL Company <br /> Signature Registered Y/ nl Fee Current Y/ N <br /> Address �icense # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License # <br /> r�acu�ni e — - - _ '�'^,'� �' <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, a Notice of Commencement is required (Mechanical work over $50D0) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http://appraiser.pascogov.com) <br />